Fatal endocarditis due to Listeria monocytogenes

Three fatal cases of listerial endocarditis were studied. The first case occurred in an apparently healthy 58-year-old man, who presented with symptoms of pneumonitis. The second case developed in a 75-year-old woman with adenocarcinoma of the lung and aortic stenosis. In the third patient, an 83-year-old woman, aortic valve vegetations with perforations were found at necropsy. A colonic adenocarcinoma was found in the first and third cases. Ampicillin, alone or with an aminoglycoside, was the antibiotic used. Urgent valve replacement was performed in the first case. Listeria monocytogenes was isolated from blood cultures in all three cases. A review of 41 other patients with listerial endocarditis showed a nonspecific clinical picture, but septic complications occurred in one-half of the cases. Thirty-nine patients had at least one predisposing factor, which was underlying heart disease in 25 cases. The mortality rate was 48%.     

Do patient characteristics,disease, or treatment explain social inequality in survival from colorectal cancer?

This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient.     

Quality of life and standard of living in a randomly selected group of psychiatrically disabled people in Sweden 2 years after a psychiatry reform.

In Sweden, a psychiatry reform, aimed at improving the living conditions of the psychiatrically disabled, came into force in 1995. The aim of the present study was to evaluate the impact of the reform by investigating quality of life and standard of living 2 years later in a randomly selected group of people with longstanding psychiatric disability. Self-ratings and interviews were conducted in a study group and a control group. The study group consisted of 19 women and 18 men (mean age 46.1 years) diagnosed with neurosis, schizophrenia or affective disorder. The control group consisted of 19 women and 17 men (mean age 48.7 years). Self-rated quality of life was significantly poorer in the study group (P < 0.0001, unpaired t-test), and so was housing (P < 0.001, test of similar proportions in independent samples). We found no significant positive correlation between subjective quality of life and standard of living in either group but a significant negative correlation in the control group (P < 0.05; r = 0.40, Pearson correlation coefficient). The results suggest that, in 1997, people with longstanding psychiatric disability still had poorer quality of life than the general population. This may be due to factors other than outward standard of living.     

Nicotine fading, behavioral contracting, and extended treatment: effects on smoking cessation

Twenty-eight subjects were randomly allocated to either a nicotine fading or a maintenance condition. The maintenance condition utilized behavioral contracting and extended treatment in addition to the nicotine fading to improve treatment outcome and avoid relapse. The maintenance condition achieved superior outcome on smoking measures at post-treatment and follow-up periods for self-reported smoking levels. Carbon monoxide levels were significantly lower for the maintenance condition at post-treatment, three month and six month follow-up. Saliva thiocyanate levels were significantly lower for the maintenance condition at the three month follow-up. Changes in health functioning indicated significantly lower diastolic and systolic blood pressure at six month follow-up for the maintenance condition. Additional research on nicotine regulation during nicotine fading and thiocyanate levels during experimental smoking would be useful. The use of behavioral contracting to enhance maintenance without therapeutic support warrants further research as well.     

Acute coronary syndromes

The first 150 words of the full text of this article appear below. Key points Coronary artery disease accounts for >30% ofdeaths in Western society. The diagnosis of myocardial infarctionshould be qualified by size, causation and time from occurrence. Mortalityis reduced by immediate or ‘primary’ percutaneouscoronary intervention or thrombolysis within the first 24 hof onset of ST-segment elevation myocardial infarction. Strategiesto reduce platelet activation (glycoprotein IIb/IIIa receptorantagonists, or clopidogrel) are now recommended in the treatmentof high-risk non-ST-segment myocardial infarction/unstable angina. Elevatedserum troponins may be the result of non-ischaemic myocardialdamage, especially in critical illness.